Medicaid Claims Resolutions Specialist

Wipro; Jefferson City (MO); On-site; USD 22,000 - 23,000; Full time

Benefits offered by this job

Medical and dental benefits

Paid time off

Job summary

Infocrossing INC, a BPS-IHS group, is seeking a Data Entry Resolutions Specialist to maintain accuracy in MO HealthNet Medicaid claims processing. You'll resolve suspended claims and attachments through evaluation and data entry in eMMIS.

You will analyze exception test pages, stage claims for clinical review with medical consultants, and communicate determinations to providers, using EOB codes to document resolutions.

Qualifications

• Strong analytical skills and meticulous attention to detail are essential.
• Ability to make informed decisions based on systematic data review.

Responsibilities

• Analyze exception test pages to determine if claims/attachments should be approved or rejected.
• Stage claims/attachments requiring clinical judgment for reviews with medical consultants.
• Explain determinations to healthcare providers to maintain transparency and relations.
• Use EOB codes to document resolutions in the eMMIS system for payments or denials.
• Keep up to date with Medicaid policy changes, system edits, and audit processes.

Job description

Infocrossing INC, a BPS-IHS group, is seeking a Data Entry Resolutions Specialist to maintain accuracy in MO HealthNet Medicaid claims processing. You'll resolve suspended claims and attachments through evaluation and data entry in eMMIS.

You will analyze exception test pages, stage claims for clinical review with medical consultants, and communicate determinations to providers, using EOB codes to document resolutions.